Gum disease is also called periodontal disease. It is defined as the inflammation of the structures that surround and support the teeth. If left untreated, gum disease may progress to the point where there is destruction of the jawbone. It is one of the most common causes of tooth loss. Periodontal disease is also a risk factor for coronary heart disease and preterm low birth weight.
Gingivitis is the earliest stage of a gum infection. It may recur or even become chronic. If gingivitis is not treated properly, it may progress to periodontitis, an inflammation of the periodontal ligament that helps hold the teeth in the bone. Periodontitis is sometimes called pyorrhea, which means a pus discharge. Severe cases of periodontitis may affect the jawbone. A severe case of gum disease that comes on suddenly is a disease known as trench mouth. Trench mouth, or necrotizing ulcerative gingivitis, is also known as Vincent's infection. It is caused by an infection of both spirochetes and fusiform bacilli. It was once a major problem for soldiers during World War I. Currently, trench mouth is particularly common among teenagers and young adults under stress , often at examination time. Inflammation from trench mouth can also spread to nearby tissues of the face and neck.
Causes & symptoms
By far, the most common cause of gum disease is poor dental hygiene. Regular daily brushing and flossing of the teeth generally clears away food and bacteria
buildup in the mouth. If the teeth are neglected, bacteria collect, and plaque forms on the teeth and gums. If the plaque is not removed, it mixes with saliva and hardens into tartar. Tartar irritates the gums and causes them to shrink away from the teeth, opening up spaces where more bacteria and plaque can collect. This cycle encourages increasingly severe inflammation and infection.
The mechanisms by which bacteria cause tissue destruction in advanced gum disease are not fully understood. Several bacterial products that diffuse through tissue are thought to play a role in gum disease. Toxins produced by some bacteria can kill cells. Studies show that the amount of endotoxin present correlates with the severity of periodontal disease. Other bacterial products include proteolytic enzymes, which are molecules that digest protein found in cells, thereby causing cell destruction. The human immune response has also been implicated in tissue destruction. As part of a normal immune response, white blood cells enter regions of inflammation to destroy bacteria. In the process of destroying bacteria, periodontal tissue is also destroyed.
Other factors can contribute to the development of gum disease. Smokers are more than two times as likely as nonsmokers to develop gum disease. Hormone levels contribute to the development of bacteria in the mouth. Thus pregnancy , puberty, menopause , and the use of
oral or injectable contraceptives may create a climate that favors the development of gum disease. Additional factors include diabetes mellitus , scurvy, pellagra, allergies, leukemia, Crohn's disease, AIDS , chemotherapy, nutritional deficiencies, hydrochloric acid deficiency, poorly fitted fillings, radiation treatments, and exposure to heavy metals (mercury, lead, arsenic, and nickel). Medications that may contribute to the development of gum disease include phenytoin for controlling seizures; cyclosporine, which is taken by people who have had organ transplants; and the calcium channel blockers used to control blood pressure and heartbeat.
The main symptoms of gingivitis are dark red swollen gums that are mushy and bleed easily. Pain is usually minimal. People with periodontitis have the same symptoms. In addition they may also have pain, loose teeth, and bad breath . Abscesses and pus may develop. The symptoms of trench mouth include sudden onset of illness accompanied by pain, bleeding gums, bad breath, and a grayish mucus that covers the gums.
A dental examination and history will be taken. As the disease progresses, a dentist will be able to find hollowed pockets near the gums. X rays may be used to reveal the breakdown of bone. A smear of the gum area may be taken to determine the existence of any bacterial infections . The visualization of spirochetes can be used to confirm the diagnosis of trench mouth.
Zinc, copper, folic acid, vitamin E, selenium , and vitamin A or beta-carotene are very helpful in slowing the progression of gum disease, especially if the patient has dietary deficiencies. Daily CoQ10 supplementation is also recommended. Mouthwashes that contain either a 0.1% folate solution or a 5% solution of zinc, or both, swished in the mouth and held there for at least a minute, can be taken twice daily.
Flavonoids help reduce inflammation and strengthen the gum tissue. A daily menu that includes foods rich in flavonoids is recommended. These foods include blueberries, hawthorn berries, onions, and grapes. Extracts of these foods may be used as well.
The main homeopathic remedy for mild gum disease is Mercurius solubilis hahnemanni in a 6c potency. Natrum muriaticum, also in a 6c potency, is for more severe disease, especially if there is formation of pus. Homeopathic remedies can be taken four times daily for up to three days.
Ayurvedic practitioners recommend a daily cup of water with the juice of a fresh lemon squeezed into it for bleeding gums. Five grams of amla powder in a cup of water daily is also recommended. The teeth can be brushed with catechu or neem powder or both.
According to traditional Chinese medicine , the gums are nourished by the liver's function. If the level of toxins in the body exceeds the liver's blood-cleansing limits, eventually the gums (and other parts of the body) become a breeding ground for disease. The Chinese also consider the liver as a reservoir of blood; it ensures that adequate blood and Qi (vital energy) are delivered to the muscles, gums, and joints.
The teeth can be brushed with a mixture of baking soda and hydrogen peroxide to clean them thoroughly and to fight infection. Goldenseal root powder, Hydrastis canandensis, can be used in the same way. Myrrh , Commiphora molmol, can be applied directly to the gums. Aloe vera may be applied directly to the gums to reduce pain and inflammation. In addition, a cup of water with a teaspoon of apple cider vinegar makes a good daily mouth rinse. An herbal mouth rinse can be prepared from 1 oz. hydrastis, 1 oz. myrrh, and 1 pint of water.
Dentists may advise mouth rinses with warm salt water as well as such measures for symptom relief as over-the-counter anesthetic ointments. The dentist will scrape away the damaged gum tissue. The root surfaces may have to be scraped. If the gums are badly damaged, surgery is performed to remove and tighten the gum tissue. Bone loss may be addressed by a of variety techniques to encourage growth. If there is advanced disease, the teeth in the affected areas may have to be pulled. Any underlying medical conditions should be assessed and treated, as they may be contributing to the gum disease. Such dental problems as poorly aligned teeth or grinding of the teeth may need to be addressed. Nutrition should be improved. If a severe infection like trench mouth is present, antibiotics will be given. The antibiotics may be delivered directly to the infected gum and bone tissues to ensure that high concentrations of the antibiotic reach the infected area. Recently, physicians have discovered that the importance of treating serious gum infections with antibiotics spreads from the patient's mouth to his or her general health. By looking for markers of inflammation throughout the body after treating some patients with gum infections with antibiotics, and not treating others, they have found oral bacteria from gum infections in arterial plaque.
Infected abscesses, especially of bone, are difficult to treat and require long-term antibiotic treatment to prevent recurrence of infection. Patients with gum disease should be reevaluated after three months to assess progress and further treatment needs.
With good dental habits, most simple cases of gum disease resolve. If the teeth and gums are not cared for or if the disease progresses for other reasons, there may be destruction of bone and a loss of teeth. Research indicates that the bacteria connected with plaque formation and chronic gum disease may enter the bloodstream and cause an infection that may bring on heart disease, pneumonia , or premature births.
The teeth should be brushed and flossed daily, after meals. Fifteen minutes per day should be spent massaging the gums with eucalyptus, witch hazel , or vitamin E, rubbing a finger in a circular motion along the gum line. Toothbrushes should be changed monthly, since there may be a tendency for bacteria to accumulate on them. The toothbrush should also be soft to avoid any further injury to the gums. A dentist should regularly check the health of the gums and teeth of people who are prone to gum disease. A dental hygienist should clean the teeth regularly, especially if there is an increased tendency to form plaque.
A whole foods diet is highly recommended. It should include fresh fruit and vegetables, and plenty of dietary fiber. Such processed foods as sugar and white bread and grains contribute to plaque formation and should be avoided. Foods high in vitamin C should be consumed daily. Vitamin C is important in maintaining healthy gums, and supplementation may also be needed. As smoking reduces vitamin C absorption, the use of tobacco products should be avoided. Calcium and magnesium supplementation is recommended to minimize the loss of bone in progressive gum disease.
The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, 1995.
The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life, Inc., 1997.
Lockie, Dr. Andrew, and Dr. Nicola Geddes. The Complete Guide to Homeopathy: The Principles and Practice of Treatment with a Comprehensive Range of Self-Help Remedies for Common Ailments. London: Dorling Kindersley, Ltd., 1995.
"Using Antibiotics for Gum Infection Helps Whole Body." Health & Medicine Week (April 8, 2002): 2.
Teresa G. Odle
Gum disease is an infection caused by bacteria that affect the tissues surrounding and supporting the teeth.
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Like getting gray hair and wrinkles, losing teeth once seemed to be an inevitable part of growing old. The number one cause of tooth loss in adults is still gum disease, also known as periodontal (per-ee-o-DON-tel) disease. This is an infection caused by bacteria that affect the tissues surrounding and supporting the teeth. About three out of four adults over age 35 have some type of gum disease. However, tooth loss does not occur until the disease is advanced. It often can be prevented by taking good care of the teeth and gums and seeing a dentist regularly.
The mildest form of gum disease is known as gingivitis (gin-gi-VY-tus). It causes the gums to become red and swollen and bleed easily. At this stage, gum disease is still easily treatable. If gingivitis is left untreated, though, it can turn into periodontitis (per-ee-o-don-TY-tis), a more serious gum disease. In advanced periodontitis, the gums and the
bone that supports the teeth can be badly damaged. The teeth may become loose and fall out, or they may have to be pulled by a dentist.
Gum disease is caused by plaque, a sticky film on the teeth made by bacteria that live in the mouth. If plaque is not removed each day by brushing and flossing, it hardens into a rough substance called calculus, also known as tartar. The bacteria in plaque produce chemicals that irritate the gums and cause infection. If left in place, these chemicals cause the gums to pull away from the teeth and create little pockets of space between the teeth and the gums. As the infection gets worse, the pockets get deeper. The result may be the destruction of the bones in the jaw that hold the teeth in place.
Most adults over age 35 have some degree of gum disease. People who smoke or use chewing tobacco, have uncontrolled diabetes, eat poorly, or have too much stress are all at greater risk for developing gum disease. Female hormones can play a part as well; girls who are going through puberty and pregnant women also are at risk.
Gum disease is usually painless in the early stage. A person might not feel it until it has reached an advanced stage. However, these are some signs that a person may have gum disease:
- gums that bleed easily during tooth brushing or flossing
- red, swollen, or tender gums
- gums that have pulled away from the teeth
- bad breath that does not go away
- pus between the teeth and gums
- loose teeth
- a change in the way the teeth fit together when the person bites
- a change in the fit of a partial set of false teeth
A dentist can check the gums for signs of disease. In addition to looking at them, the dentist can use a probe with a special rounded tip. This probe is moved gently around the gum line to search for pockets in the gums.
Treatment depends on the type of gum disease and how far along it is. Cleaning the tooth surface and the root below the gum line helps the gum tissue heal and reattach to the tooth surfaces. Antibiotics can help control the growth of bacteria.
If the pockets are too deep to clean inside, the dentist may need to perform surgery to shrink the pockets. If part of the bone supporting the teeth has been destroyed, further surgery may be needed. Such surgery can reshape or rebuild the bone that has been lost.
Brushing and flossing the teeth helps remove plaque. In the early stage of gum disease, brushing twice a day and flossing every day usually will cure the problem. Guidelines include:
- Using a soft-bristled toothbrush.
- Picking a brush that feels comfortable and will reach all the teeth, even those in back.
- Replacing the brush when the bristles show signs of wear.
- Brushing with a short, gentle, back-and-forth motion.
- Remembering to brush the inside surfaces, the back teeth, and the tongue.
- Flossing to reach plaque between the teeth and under the gum line, where a brush cannot go.
It also is important to see a dentist regularly for checkups and professional cleanings.
American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The leading national organization for dentists has information about gum disease and dental care on its website. Telephone 312-440-2500 http://www.ada.org
U.S. National Institute of Dental and Craniofacial Research, 31 Center Drive, MSC 2290, Bethesda, MD 20892-2290. Part of the U.S. National Institutes of Health (NIH), this agency publishes brochures and posts fact sheets at its website about gum disease and mouth care. Telephone 301-496-4261 http://www.nidcr.nih.gov